HomeMy WebLinkAbout0207 ARROWHEAD DRIVE - Health 207 Arrowhead "wi
077 4.
9
i
Massachusetts Department of Environmental Protection
` 100316225
--- BWP AQ 04 (ANF-001) Asbestos Project#
Asbestos Notification Form
- r1 Project Revision' 1
r Project Cancellation
_ r
A. Asbestos Abatement Description
,
1.Facility Location: i
JARZOBSKI <MA02601
RROWHEAD DRIVE
Instructions 1.All a.Name of Facility eet Address
sections of this form BAf2NSTABLE
must be completed in 00000 00
order to comply with a City/rown d.State e. Code f. ephone
MassDEP notification X X
requirements of 310
CMR 7.15 and 'g.Facility Contact Person Name h.Facility Contact Person Title
Department of Labor Worksite Location: BASEMENT
Standards(DLS)
notification i.Building Name,Wing,Floor,Room,etc.
requirements of 453 2. Is the facility occupied? R,a.Yes r b.No
CMR 6.12
3. Is this a fee exempt notification(city,town, district, municipal housing authority, state facility, or
owner-occupied residential property of four units or less)? r a.Yes r b.No
MassDEP Use Only
4.Blanket Permit Project Approval,if applicable:
Date Received Approval ID#
5.Non-Traditional Asbestos Abatement Work Practice Approval,
if applicable: Approval ID#
6.Asbestos Contractor:
NEW ENGLAND SURFACE MAINTENANCE LLP 850 WASHINGTON ST
a.Name b.Address
WEYMOUTH MA 02189 7813372117
c.City/Town d.State ; zip Code t Telephone i
A0000196 h.Contract Type: r 1.Written r 2.Verbal
g.DLS License#
? JOHN P.VAWQUETTE AS060773
a.'Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification#
,
8 RICHARD K BOWEN AM061044 ,
a.Name of Project Monitor b.DLS Certification# r
9 FLI ENVIRONMENTAL INC AA000144
a.Name of Asbestos Analytical Lab b.DLS Certification#
10.
10/4/2019 10/4/2019
a.Project Start Date(MM/DD/YYYY) b.End Date(MWDD/YYYY)
8-4 N/A
c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday
11. What type of project is this?
t
[i a.Demolition �; b.Renovation r— c.Repair d.Other-Please Specify:
. t
Revised: 11/13/2013 Page 1 of 4
i
Massachusetts Department of Environmental Protection
100316225 '
BWP AQ 04 (ANF-001) Asbestos Project#
Asbestos Notification Form r Project Revision
r, Project Cancellation
i
A.Asbestos Abatement Description: (cont)
12.Abatement procedures(check all that apply): k
ri a.Glove Bag r b.Encapsulation rl c.Enclosure r d.Disposal Only r e.Cleanup ,.
r f.Full Containment r g.Other-Please Specify: i
13.Job is being conducted: rl .a. Indoors r b.Outdoors
14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or j
encapsulated:
t
50
1.Linear Feet(Lin.Ft.) ; 2.Square Feet(Sq.Ft.)
b.Boiler,Breaching,Duct, c.Transite Pipe
,
-Tank Surface Coatings 1.Lin.Ft 2.Sq.Ft 1.Lin.Ft 2.Sq.Ft.
d.Pipe Insulation e.Transite Shingles
1.Lin.Ft. 2.Sq:Ft. 1.Lin.Ft. 2.Sq.Ft. r
f. Spray-On Fireproofing g.Transite Panels a ,
,
1.Lin.Ft 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft.
h.Cloths,Woven Fabrics i.Other-Please Specify:
1.Lin.Ft 2.Sq.Ft.
I
j.Insulating Cement DUCT PAPER INSULATION 50
1.Lin.Ft 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. i
15.Describe the decontamination system(s)to be used:
AS REQUIRED
16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2).
(g): '
AS REQUIRED I
i
t
17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency:
a.Name of MassDEP Official b.Title of MassDEP Official `
c.Date of Authorization(MM/DD/YYYY) d.Waiver#
e.Name of DLS Official f.Title of DLS Official
g.Date of Authorization(MM/DD/YYYY) h:Waiver#
i
18.Do prevailing wage rates as per M.G.L.c. 149, § 26,27 or 27A—F apply to this r a.Yes rj b.No
proj ect?
" I
Revised: 11/13/2013 Page 2 of 4
f
v
Massachusetts Department of Environmental Protection 100316225 �
BWP AQ 04 (ANF-001) t
Asbestos Notification Form Asbestos Project# t
j Project Revision {
• r Project Cancellation ,
I
B. Facility.Description
RESIDENCE i
1.Current or prior use of facility: i
2.Is the facility owner-occupied residential with 4 units or less? r a.Yes C b.No
3 JARZOBSKI 207 ARROWHEAD DRIVE
a.Facility Owner Name b.Address 4
HYANNIS MA 02601 OOOOb00000 ±
c.City/Town d.State e.Zip Code f.Telephone
4.x x
a.Name of Facility Owner's On-Site Manager b.Address !
x MA 00000 0000000000
c.City/Town d.State e.Zip Code f.Telephone F
r
x x
5.a.Name of General Contractor b.Address
• r
x MA 00000 0000000000
c.Cityrrown d.State e.Zip Code f.Telephone i
x
g.Contractor's Worker's Compensation Insurer
x 1/1/2020
i
h.Policy# i.Expiration Date(MM/DD/YYYY) ;
1400 2
6.What is the size of this facility?
a.Square Feet b.#of Floors
Note:Temporary storage of Asbestos C. Asbestos Transportation & Disposal
(
containing waste material is only 1.Transporter of asbestos-containing waste material from site of generation:
allowed at the place r a.Directly to Landfill or r b.To Temporary Storage Location/Transfer Station
of business of a DLS
licensed Asbestos F
contractor or a transfer NEW ENGLAND SURFACE MAINTENANCE,LLP 850 WASHINGTON STREET
station that is c.Name of Transporter d.Address
permitted by f
MassDEP and WEYMOUTH MA 02189 7813372117 I
operated pliance with Solid in
com e.City/Town f.State g.Zip Code h.Telephone
Waste Regulations
310 CMR 19.000 2.If a temporary storage location/transfer station is used,list name of transporter of asbestos containing f
waste material from temporary storage location/transfer station to final disposal site: r
RED TECHNOLOGIES 10 NORTHWOOD DRIVE
a.Name of Transporter b.Address
BLOOMFIELD CT 06002 8602182428
c.City/Town d.State e.Zip Code f.Telephone
1
i
1
Revised: 11/13/2013 Page 3 of 4
r
Massachusetts Department of Environmental Protection 100316225
BWP AQ 04 (ANF-001)
Asbestos Notification Form Asbestos Project#r Project Revision
ri Project Cancellation
C..Asbestos Transportation&Disposal: (cont.)
3.Name and address of temporary storage location/transfer station for the asbestos containing waste
material'
REDTECHNOLOGIES 203 PICKERING STREET
a.Temporary Storage Location Name b.Address
PORTLAND CT 06480 8603421022
c.City/town d.State e.Zip Code f.Telephone
4.Name and location of final disposal site(asbestos landfill):
MINERVA ENTERPRISES MINERVA
a.Final Disposal Site Name b.Final Disposal Site'Owner Name
9000 MINERVA ROAD
c.Address
WAYNESBURG OH 44688 3308663435
d.City/Town e.State f.Zip Code g.Telephone
Note:Contractor must
sign this form for DLS
notification purposes D. Certification
KEN FURTNEY KEN FURTNEY
"I certify that I have personally 1.Name 2.Authorized Signature
examined the foregoing and am PARTNER 9/18/2019
familiar with the information
contained in this document and 3.Position/Tide 4.Date(MM/DD/YYYY)
all attachments and that,based 7813372117 NESM,LLP
on my inquiry of those 5.Telephone 6.Representing
individuals immediately 850 WASHINGTON STREET WEYMOUTH
responsible for obtaining the 7.Address 8.City/Town
information, I believe that the MA 02189
information is true,-accurate,and
complete. I am aware that there 9•State 10.Zip Code
are significant penalties for
submitting false information,
including possible fines and
imprisonment.The undersigned
hereby states that I have read the
Commonwealth of
Massachusetts regulations
governing asbestos abatement
(453 CMR 6.00 promulgated by.
the Department of Labor
Standards and 310 CMR 7.15
promulgated by the Department
of Environmental Protection),
and that I am aware that this
permit application or notification
shall not be deemed valid
unless payment of the
applicable fee is made."
Revised: 11/13/2013 Page 4 of 4
TOWN
r(OF BARNSTABLE
°LOCATION t2y 2 AieoC.t���aA SEWAGE# Za08" 14
VILLAGE Z27V1 141 S /AJSSESSOR'S MAP&PARCEL 'Z'70 - -1'7
INSTALLER'S NAME&PHONE NO. G'A p.Q,62 ,L L L L
SEPTIC TANK CAPACITY 15 po �3 A L
LEACHING FACILITY:(type) "((2anchL2� (size) -2 c o,w�e,s ire
NO.OF BEDROOMS
i
OWNER 7ownne. TAC-LC>6s+t%
PERMIT DATE: 10-20,10 0 8 COMPLIANCE DATE: i • 2 l " Z ooS
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility AD wv,�IIO ((•3 feet
Private Water Supply Well and Leaching Facility(if any wells exist
on site or within 200 feet of leaching facility) feet
Edge of Wetland and L'-aching Facility(if any wetlands exist
within 300 feet of leaching facility). feet
FURNISHED BY
w
i• TOWN OF BARNSTABLE �
LOCATION J0 7 Aff-a(,J"a ) SEWAGE# —'0
VILLAGE \ ✓\n ,•) ASSESSOR'S MAP&PARCEL 77
INSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITY /-Q G
LEACHING FACILITY:(type) yj (size) 3 X I o
NO.OF BEDROOMS
OWNER c `S�c
PERMIT DATE: 10 296LO'9- COMPLIANCE DATE: �I
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /Vd 6j Feet
Private Water Supply Well and Leaching Facility.(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
FURNISHED BY
N
n
oQ
N —
Qll
:Y
No. .
—0 Fee D
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Yication for &.5 oeal 6potem Cow6trUCtion Permit
Application for a Permit to Construct( ) Repair(4). Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ,,. Owner's Name,Address,and Tel.No. ,oSe01` Ja%%A.0 cJ,r 20
1�3tQ SOV Vi96 Cie(_\-
Assessor's Map/Parcel
V�Qe—,.�.� QctiSc �L. C^S�ncPn
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
5Z%-y t%- �_w c$ V0 3 o T 1�3 2 i'>>L1
Type of Building:
Dwelling No.of Bedrooms Lot Size 1016CVO A- sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures Design Flow(min.required) Q�� gpd Design flow provided ® \ gpd
Plan Date Z00 Number of sheets 1, Revision Date
Title _'P(M�01�C-A_d oS , 0,rX
Size of Septic Tank \J by (ti Type of S.A.S. $'\� -A cL
Description of Soil 5p—p n , !� 'Su,
Nature of Repairs or Alterations(Answer when applicable) bkU:) `
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Boa d of Health.
Signe n G Date D- Z
Application Approved by Date
Application Disapproved by: il, Date
for the following reasons
Permit No. jr Date Issued
=---•w -�...:,.-.`..•ti ,.. � - v.f..:..:.:..•..,y�._.._. - -� _�,�-�....v.=�v-.....sr.�.--,:tw+.F..-w;..,_---�"` ..V
,000D D
No:- � � , �,� � � -; + D66D Fee
THE CO,' MONWEALTH OF MASSACHUSETTS
Entered in computer: ,
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppYitation for �DizpogaY 6pztem Con.5truction Permit
Application for a Permit to Construct( ) Repair'(JC) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. oC.�� ���w\t Q 0. ?C ` C Owner's Name,Address,and Tel.No.,oS�,!\�' ,cX..�a t ��.r z obS �,
Assessor'sMap/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
`�
\' �T `�ti3 a 2� z�5L1 (Jq,.lcc"��
`
Type of Building:
".
Dwelling No.of Bedrooms Lot Size It.,$CA0 sq. ft. Garbage Grinder ( ).
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) C gpd Design flow provided � d `1 gpd
Plan Date ^p' �� 2 00 Number of sheets \ Revision Date j
Title -J�� ��`act.G� -D ,�1 F , ��-i a r n t S .
Size of Septic Tank Type of S.A.S. S' AD
Description of Soil JG-r 7�Ct C� ( � 6�
Nature of Repairs or Alterations(Answer wh applicable)
Date last inspected: i,
Agreement:
- The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental.Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. /�+
Sign e �F_ ///A P e, Date
Application Approved by _ Date
'?
Application Disapproved by: Date
{ . for.the.following reasons
\ Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( )
Abandoned( )by G D v- W A-e
at 01 Prcrow� �.d !7C • V\ h been c�struc a ac6 rdance
with the provisions of Title 5 and the for Disposal System Construction Permit Nc �� dated
Installer�GPC .� , � �_ \���4o�i)c� Designer
J
#bedrooms �, Approved desi flow gpd
The issuance of this permit shall. •of be construed as a guarantee that the system ill func •on designed.
Date / �� I '0� Inspector
--- ————————
Now.�_--_------———————--.---------— Fee /^
THE COMMONWEALTH OF MASSACHUSETTS
r
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
Mitpogar *pltem Congtruction Permit
Permission is hereby granted to Construct ( ) Repair (,C ) Upgrade ( ) Abandon ( )
System located at C�'1 -a,,���ec: c\ �� ��IP �. .� c� S
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Construction rildst be omp`eted within three years of the date of this pe
Date Approved by y
- own of nar,
- ' ,ns: late � •
i
Regulatory Services ;
0 RA!' ot,
"Thomas F. Geiler, Direciorublic Health Division
; i TOomea McKean' Director
�200 Main Street,Ayannls,!MA 02601i j!
office: 508-802 4644
i ! Fax; 508•'790-6304
i
Installer &Designer r Cm catia, n rnQ m
Date; 16: Z"7- p � ► I I 4 '.t
„
'nee
6'�lle' > .i ��C-,
> a Installer: C -It e-IIL e-
0 Address: _14 C r�r•be cri t4 wYT; Address: QeCo�C Zco _
On D " ZO" — ►_ iu iv was issued a perimit to install a
�T _
(installer} , I : ! '; I ►
septic system at 2b"7 Air rowln e c,� �_ i;U ; based'on`a design drawn by
! i _ . --------- address) — - ----r • I
ij _^T1 C,` . .ri �``� i �� dated 4c kdv�eri I ! zou I f
it '(designer) .-►.W._._ I i I ? ►
_!ZI� certify that the septic System referenced above;wae installed-substantially according to i
the cie®t which may include minor approved ch l b
gni Y pp az�gesl eachs'lateral relocation of the
distribution box and/or septic tank. I !
I certify that the septic system referenced above was installed with major changes �►.e,
Ir greater than 10' lateral relocation of the SAS or any vertical relocation of any component �
of the'
septic system) but in accordance with State &,Local Re�ulitions. Plan revision or
certified as-built by designirr to follow,
II '(Inst SS
igc. .i><°
i
(Designer s 7- r
e) (Af i esi$ner s i snap Here)
PLEAS 'TUB rUB E TH DIVISION. CERTIFICATE
FCOMPLIANCE
CO I C �
On DIVISION.I THANK ! I
Q. Heaith/SeptioNesig er Certmeat,op Farm
i � I
{ I ►� 'd i 1920 £LZ 80S ! ONIa33NION30r Wd 20: £0 SOOZ—LZ-100
Bk '23219 P92.43 0 53814
.T
DEED RESTRICTION
WHEREAS, �o inn cbs4C
(owners name) Of'
�wlne. ����
2
{address) _ MA
is the.owner of 0-7 . 6-, . 4 c r; c
taddress) located .
at
MA (hereinafter referred to as, 2_o'1
and being shown on a plan entitled."Subdivision of Land in
Hann► s . 6A��� ,�► MA P, Pro ertY of
et al, duly recorded in.Barnstable Coun
of ty Registry
Deeds in Plan Book 1
'Page
Or on Land Court Plan Number
WHEREAS, . So�� n'e. . SR2zo�s�; as the own .(owners name) owner Of said 'lot has
agreed with the Town of Barnstable Board of Health to a restriction as to the
number.of bedrooms which can be included in any home built on said lot as a
pre-condition to°obtaining a disposal works construction-p'ermit iri com Tian
With 310 CMR 15.000 State Environmental Code, Title V, Minimum p Ce
Requirements for the Subsurface Disposal of Sanitary Sewage;
WHEREAS, the Town of Bamstable Board of Health, as a Pre-condition-to
granting a disposal works construction permit for a septic system in compliance
with 310 CMR 15.200I State Environmental Code, Title V,. Minimum
Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizin
.the'issuance of a building permit for the construction of a single family home on
this property, is requiring that the agreement for the,restriction on the
bedrooms in any house constructed on the lot.be Put-on.record with umber of
Barnstable County Registry of Deeds by recording this document, the
dee&
NOW, THEREFORE, Toranne TAAz.o0sY,, does hereby place•the
(owner's name)
following restriction on his above-referenced land in accordance with his
aa�'e� ement with the.TDwmof , whie •restrietion SW
run with the-land and be binding upon all,successors in title: .
1 0-1 40-6,.oke,4A Drive C ;���i S may have constructed s
(address)
upon the lot a house containing no more than 'fWa (Z,) bedrooms.
�oAn�e SAKZILIG agrees that this shall be-permanent deed
(owners name)
restriction affecting LoT*t.o located on z07 1qrrCL-Neal Dr MA, acid
being shown on the plan recorded in Plan Book i8ssy , Paged 56 . .
Or on Land Court Plan
.For title of see the following deed: Book 159. , Page
U( ...,Or Land Court Certificate of Title Number
Executed as a sealed instrument _day of
Own s signature
Owner's signature
-Owner's signature
COMMONWEALTH OF MASSACHUSETTS
ss
20
Then personally appeared the above-na-Med
R J A ,
known to me to be the-person who executed the foregoing instrument and
acknowledged
the same to be "WFie- free act and deed, before me', DONNA 1• LEE
Nota,ypu- C
Commonwealth of Massachusetts
Mp Commission Expire s.
i N June 19,2009
Public
'My commission expires-
\T4&A- ( �( � pZ U a f ..
(date)
6-le&
Town of Barnstable P#
Department of Regulatory Services
oFVEr, Public Health Division Date
200 Main Street,Hyannis MA 02601
% eArwsreeM
�OtED�.'1•`s Date Scheduled Time FeePd.
Soil Suitability Assessment for Sewage Disposal
Performed By: 1 I4� &P../1 W I i i C S Witnessed By, fn✓V
r..._.u!2n:'1�.2f.c¢:u2::d!f!:di4:6,!2!.Y.JG..ur...3._r:r: ,__. �r.,...,,_ _�..:rc:.`._...::':. F.:::_:•t�..::-.v�-'i•=:�-
r_..uJ'r.:.-=.. !.:LY'
" !'�"!_ ...h i,r, .. rl:. !'l;r:�.rr:L: r.
/ A eQy� TT gyp '�d� l G r. �b!'"a �,:'!=:2:i:: y..:hi;d-;�,!T!,��'y/'4j.,k�: � �T"'�y��!�f�� L�.,r x ;.^.�a� 1"m�F�!4'SF.IIT:I,u d�d.r Yr' ;'r'!+ri. ,�(u� -
1;,7 S��Y±!+.ti�ri:liwi�'!�•m?`dY41;!�•!u'���.r�'''.ayo!'w.'cl;it;ro_Tuy _. ���u' �.:a9W!L'T.r_,r �,:; ± 4 s ! i �!19.!M i u"y4 rl i h i' ,.4",'r.�y
Location Address -
a 0-7 /-12/2or u /,k- RC.� t},("V 6- Owner's Name b 4 n,7 e -SA27
I +Cl ffiS K;
n+3 Address 207
Assessor's Map/Parcel Z 7plo-7� Engineer's Name 1
^ NEW CONSTRUCTION REPAIR Telephone# )_op y 71 YOZ8
Land Use 540e- F0, ity /(estdeVk('Q1 slopes(%) 1' Z Surface Stones `
Distances from: Open Water Body 7l00 ft Possible Wet Area 7 1G0 ft Drinking Water Well t''IA ft
Drainage Way 'i!0 O ft. Property Line 7 10 ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test boles&perc tests,locate wetlands in proximity to holes)
N
. a
C)
w co
d co
;n C3 .
40
CV ' co
.ma's CL. X O r
m
y m
J c
11, •
Parent material(geologic.) g1 C14G' oU}uUG511 Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: 13 b55 Weeping from Pit Face 7 5 S
Estimated Seasonal High Groundwater
. r=c,."-±.=c.=:r: ::m•.N:b?'f7�I,!. n :;fT :q.:.2!:!!p:r.,n!xL r�!e�p'r,q!firr.C:vdS,Irr!mma,:::
'4' ! w. [ i !}. .LII"!I°!1!
! � IL "t ^! W LLJ.i' �1' 1'li!!,itL.l ,'v��i!'.IL!!i!Iq F!'�I:v�!
.r! .r:,.:,:r,r:L:rlr:m! r._==:.: 1011':,:F.".!:._::::
Method Used: VXeCA Obse Wait( t
Depth Observed standing in obs.hole: 7 13. in. Depth to soil mottles: >134 in.
Depth to weeping from side of obs.hole: 7 13(. in. Groundwater Adjustment ft.
Index Well# — Reading Date: — Index Well level — Adj.factor Adj.Groundwater Level=
:-!':!!:!::•,:::-:=FS .::::-:.-.__.._..__._....._.....
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�...__ •eW,`L' +::..vl'_!''t:r:i. r}=ia:!r:'r...._:. ::::, .: :!.: !..,. 5'"'"•.,rd�:r, -
-I• :li:::!.{,:-3_r..::........:..r.._.".!!v._LL::i:Ad!c'r=- :.'.L I i - ..:!!CC!!C•!!L:rs'ii_!�" �4'�' - .r,; .!' t..
.., :_.m;.Y'':?:_vFrr-:vr,......._. :.....__ ._ I.,n.._..__:,....,..... - I::.. '!it:
PT.�+ I�.T.:..':.= ��..T� �' � ':. y�.
.:.rr:.:".d.�Rr.rt 8.4:,,�,r_!... ,�,:�-,.'v!2dcr'=.di__.=bu.r:;.r5;•id _A �y..iir�IjC"L•'�?'+•+t' �a.I..:v ��.) ..�:{+•a
' Fd"_L....J_:._,..,....!L:_n w..0 44:,:�:r,,.Lr'rr,.5:..a,wt.fL_.".n.u.rrr_:__.t:r:._:v.::ri'..i '.. v._-._.._'"^����r°. _ �1 „•>v ,:, '-
._rus....._c:eve�_urn.c�.......nv:r::.ulav_:-:I::,._n�::aa.�-=:�r::�._4:h!1-r'na'I,��vxn•M-e1r.Y:'�3...::�'-..+.....n_..'.i�r.cu .........:...":
Observation _
Hole# Time at 9" '
Depth of Perc j '-.5 y Time at 6"
Start Pre-soak Time @ I I f y A Time(9"-6")
End Pre-soak 11.ZY All r
Rate Min./Inch 4'2
Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed(Y/l) ti
Original: Public Health Division Observation Hole Data To Be Completed on Back----- -
Q:HF,ALTH/WP/PERCFORM
Depth from Soil Horizon Soil Texture Soil Color ': Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consislencyb°
3b L S -s/e — —
3�'�3to N-es 2,SYb/�, -- S-�o% Sra�Zl Cvoc�e Cdi4/S
Depth from Soil Horizon Soil Texture SoII Color Soll Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency.%Gravel)
4-3 L S GU i S/e —
3�'l36 L /t'GS 2. I e�6 — SOU/a�cl,el vonesol�c� CC�o f S
f .
.......:,....:...:...:::..::.:...:. .::.:.:::......:.:: ... : .....:..:,.. ...:.. ...:: .:. . .:,: ..::::.::::::.:::::::::.:::::::::,.::::::::::..:::::
Depth from Soil Horizon Soil Texture Soil Color Soil Otherl...............
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistencv.°
I '
P::OB.SHAT�:ON.H.. .�, ..�. .. ....................... :.....:......:..................
Depth from Soil Horizon Soil Texture Soil Colo Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
° r
Flood Insurance Rate Mao:
Above 500 year flood boundary No_ Yes lI
Within 500 year boundary No Yes
Within 100 year flood boundary No ✓ Yes
Depth of Naturally Oceurr>_ng Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the.soil absorption system? �'e5
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on f6� g 5 (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection-and that the above analysis was performed by me consistent with
the required training,expertise and ex hence described in 310 CMR 15.017.
Signature Date �b /5 0
I
------------
4"SCHEDULE 40 PVC MIN. SLOPE 1% FINISHED GRADE OVER INFILTRATION= 49.4' - 49.2' GENERAL NOTES
TOP OF FOUNDATION = 50.5' ± INISH GRADE OVER D-Box= 49.2'± SLOPE @ 2% MIN. 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS
PROVIDE CONC. RISER WITH ACCESS PORT WITH SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL CODE AND ANY
COVER OVER INLET&OUTLET FINISH GRADE OVER TANK EL.= REMOVABLE COVER OVER RISER TO ACCESS BOX TO WITHIN INSPECTION PORT w/ACCESS BOX APPLICABLE LOCAL RULES.
FINISHED GRADE TO WITHIN 6"OF F.G. WITHIN 6"OF FINISHED GRADE 6-OF F.G. (ONE PER ROW) 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
@ FOUNDATION = 50.0'± 5- DIA. OUTLET(S) --------- DESIGN ENGINEER.
49.5'± SEE NOTE#21
- i20"MIN.ACCESS 36"MAX. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
COVER(3 TYP.)_ 12" MIN. ---- ---- 9"MIN. SYSTEM UNLESS OTHERWISE NOTED.
9"MIN. 36"MAX. TOP OF SAS B.O. 46.43' 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN
EXIST. SEWER Plp= 36"MAX.
FELEVATION =46.43' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS
2' DROP MIN. PROVIDE WATERTIGHT A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF
MIN.SLOPE 6" 3' 3' DROP MAX. 3" 9" THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
JOINTS(TYP.) 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
f <
fh6"o TYP 5.
PROP. PVC 1 4" PVC IN FROM (TYP.) 16"TYP
SEWER PIPE] 14" SEPTIC TANKO 4"PVC OUT TO 0.90, 00 10.75, TYP 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
6.50' LEACHING FACILITY 00 1 j 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED PRIOR TO BACK FILLING WHEN SYSTEM IS
/*47.1'+ 46.75" - 1 12" 17'\ 1 46.00' 45.10' (laid flat) _2.88'(34.51_� NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS NOT TO BE BACK FILLED
OUTLET TEE 46.27 MIN. 46.10' (TYP.) WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH.
48 5.0' 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 50.00' ESTABLISH ON A NAIL SET
�-22"ZABEL FILTER MODEL 6"CRUSHED STONE (TYP.) 5'MIN.
#Al 801-4x22(GAS 11.50' IN A FENCE POST AS SHOWN ON PLAN.
OVER MECHANICALLY
-I O.O'TO FND COMPACTED BASE 20.0'(TYP FOR BOTH ROWS) 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION THROUGH
BAFFLE ON BOTTOM) DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT 1-888-DIG-SAFE
5 OUTLET DISTRIBUTION BOX AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES TO THE DESIGN
OVER MECHANICALLY
6" CRUSHED STONE TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 38.57' ENGINEER.
COMPACTED BASE BASE. FIRST TWO FEET OF OUTLET BIODIFFUSER (PROFILE) BIODIFFUSER END VIEW 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE
PROPOSED 1500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. WATERTIGHT.
LENGTH 10' 6' WIDTH 5' 8" DEPTH 68" (Dimensions per Wiggin CROSS SECTION VIEW 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
SEPTIC TANK PROFILE Precast Corp., Pocasset,MA) DISTRIBUTION BOX DETAIL 8 1611 HIGH ARC 36HC (#3616BD) BIODIFFUSERS REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
CONTRACTOR TO VERIFY ELEVATION NOT TO SCALE NOT TO SCALE NOT TO SCALE APPROPRIATE AUTHORITY.
---------- ---------------- ------- ---------- 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED
N. SWING TIE MEASUREMENTS TEST PIT DATA UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND
H-20 LOADING, OR AS INDICATED ON PLAN.
• • 12388#:PERC
DESCRIPTION HC 1 HC 2 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.
INSPECTOR: David W. Stanton, R.S.
SEPTIC COVER IN (1) 11.5' 17.7' 4 29 • EVALUATOR: Michael Pimentel, E.I.T. 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
SEPTIC COVER OUT(2) 19.3. 21.8' DATE: October 15, 2008 MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. REPLACE
ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, FINES OR OTHER
BIODIFFUSER CORNER(3) 46.0' 40.9' 0 TEST PIT#: 1 UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
W. E. BIODIFFUSER CORNER(4) 65.9' 60.5' ELEV TOP 49.90' 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN SITE
I # .7 1 CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
ELEV WATER= <38.57'
BIODIFFUSER CORNER(5) 65.6' 633 16. PROPOSED PROJECT IS LOCATED WITHIN:
W if/, PERC RATE <2 MIN./IN.Cr) BIODIFFUSER CORNER(6) 45.7' 44.8' LOC US ASSESSORS MAP 270 LOTS 77
DEPTH OF PERC= 36"-54"
TEXTURAL CLASS: 1 TEXTURAL FLOOD ZONE C ON PANEL# 2500010005 C
U')
OWNER OF RECORD: JOSEPH A. &JOANNE M. JARZOBSKI
0. Fill 49.90' ADDRESS: 1636 SOUTH 186 CIRCLE
0
PROPOSED ACCESS PORT
0 1 (n WITH ACCESS BOX TO • 4" 49.57' OMAHA, NE 68130
<z GRADE (TYP OF 2)
S J • 0 B Loamy Sand
Benchmark 0 1 OYR 5/6 17. PLAN REFERENCE: 1.) PLAN BOOK 159, PAGE 41 2.) PLAN BOOK 219-93(L.O.)
PROPOSED TOTAL 8 ARC Nail in Fence Post
ost
36HC BIODIFFUSERS Elev. =50.00 MAP 270 1 36" 46.90' 18. DEED REFERENCE: DEED BOOK 18554, PAGE 50
(4 BIODIFFUSERS EACH Approx. •M.S.L. Perc
M PARCEL 78 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
TRENCH) z 00 0 1 54" 45.40'
20. PROPERTY LINE INFORMATION IS APPROXIMATE ONLY. THIS PLAN IS TO BE USED ONLY FOR
PROPOSED DISTRIBUTION BOX SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY FOR USES OF
• C Medium-Coarse Sand THIS PLAN OTHER THAN ITS INTENDED PUPOSE.
2.5Y 6/6
S77-
CS 1 PROPOSED 1500 GALLON (5-10%gravel) 21. A 4"PERFORATED SCH.40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A DEPTH
SEPTIC TANK -EXISTING CESSPOOL TO BE Z E (variegated colors) OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISHED GRADE. A REMOVABLE
MAP 270 14 PUMPED, FILLED WITH CLEAN THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS.
PROPOSED
PARCEL 50 \610 (5 INSPECTION PORT SAND AND ABANDONED
0)
6) 119, LOCUS PLAN- 136"' 1 38.57'
No Mottling,Weeping or
SCALE: 1" 1000'
TP 1, ARE Standing Encountered
0 TP 2. TEST PIT DATA
49.90
C\f (4 DESIGN DATA PERC#: 12388 LEGEND
r- CID lid
z 0.0, 3) 0 INSPECTOR: David W. Stanton, R.S.
NUMBER OF BEDROOMS (DESIGN) 2* X50 EXISTING SPOT GRADES
EVALUATOR: Michael Pimentel, E.I.T.
(2 49
�V DESIGN FLOW 110 _GAUDAY/BEDROOM - - - 50 - - - EXISTING CONTOUR
0 10.01 '__1 i DATE:- October 15, 2008
\_HC-1 PROPOSED C/O WITH 90' TOTAL DESIGN FLOW 220 GAUDAY TEST PIT#: 2 PROPOSED SPOT GRADES
__W
I It LONG SWEEPING BEND ------ DESIGN FLOW X 200 % 440 GAUDAY ELEV TOP 49.90'
W 91 PROPOSED CONTOUR
z USE PROPOSED 1,500 GALLON SEPTIC TANK
co ELEV WATER <38.57'
CV) EXISTING OVERHEAD UTILITIES
UJ * DEED RESTRICTION TO BE FILED
W SHED C? PERC RATE
rr A& HC-2 CV Li A S EXISTING GAS LINE
#207 COh
INSTALL 8 - 16" HIGH ARC 36HC (#3616BD) BIODIFFUSERS DEPTH OF PERC W W EXISTING WATER LINE
BH EXISTING `SHRUB TEXTURAL CLASS: 1
MAP 270 2-BEDROOM TEST PIT LOCATION
SHRUB SYSTEM CAPACITY
PARCEL77 DWELLING 49.90'
TOF 50.5'± Fill 49.57' PROPOSED 1500 GALLON SEPTIC TANK
11,237 S.F.± (TOTAL L.F. OF BIODIFFUSERS)(7.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD 4"
PROPO
SHED (40.0')(7.8 SFILF)(0.74 GAUSQ.FT.) 230.9 GAL. LEACHING DAY SED 4"SOLID SCHEDULE 40 PVC PIPE
a 0 B Loamy Sand 13 PROPOSED DISTRIBUTION BOX
1 OYR 5/6
IT
TOTALS:
WPROPOSED 16"HIGH ARC 36HC(#3616BD)BIODIFFUSER
36" 46.90'
TOTAL NUMBER OF BIODIFFUSERS: 8 PROPOSED 16" HIGH ARC 36HC(#3616BD)COUPLING
\ i j0 TOTAL NUMBER OF COUPLINGS: 0
CHIMNEYSHRUB Q� ,zt 8Q TOTAL LEACHING AREA: 312.0 SQ.FT.
ir
LL 11:r TOTAL LEACHING CAPACITY: 230.9 GALJDAY
hu C
0 Medium-Coarse Sand DATE BY APP-D. DESCRIPTION
IV77- ---------------
12�2,4-W 2.5Y 6/6
PROPOSED SEPTIC SYSTEM UPGRADE
149.79, Uj (5-10%gravel)
NOTE: (variegated colors) PREPARED FOR:
BIT. DRIVEWAY EFFECTIVE LEACHING AREA OF 7.80 SF/LF OBTAINED FROM THE CAPEWIDE ENTERPRISES
DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER ---- -----
"MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO LOCATED AT
GAS k ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST
MODIFIED JULY 23, 2008). TRANSMITTAL NUMBER=W000052. 207 ARROWHEAD DRIVE
MAP 270 N 136"' o Mottling,Weeping or 1 38.57'S HYANNIS, MA
PARCEL76 Standing Encountered
BOARD OF HEALTH USE SCALE: 1 INCH = 10 FT. DATE: OCTOBER 15,2008
0 5 10 20 40 FEET
OF
JOHN L. PREPARED BY:
0 CHURC III L
i . JC ENGINEERING, INC.
NOTE: NO 4113 2854 CRANBERRY HIGHWAY
1. MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP SITE PLAN EAST WAREHAM, MA 02538
EDGE OF EACH SEPTIC SYSTEM COMPONENT. 508.273.0377
SCALE
2. PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2. : 1"= 10' -_
Drawn By: BSM Designed By: MCP C TJ61B#: 1501
------------------------------ ------- ------ ------------- ----------- ------------ --------